Background
Australia, unlike most high-income countries, does not have published benchmarks for
cardiac rehabilitation (CR) delivery. This study provides cross-state data on CR delivery
for initial benchmarks and assesses performance against international minimal standards.
Methods
A prospective observational study March–May 2017 of CR programs in NSW (n=36), Tasmania
(n=2) and ACT (n=1) was undertaken. Data were collected on 11 indicators (published
dictionary), then classified as higher or lower performing using the UK National Audit
of Cardiac Rehabilitation (NACR) criteria. Equity of access to higher performing CR
was assessed using logistic regression.
Results
Participants (n=2,436) had a mean age of 66.06±12.54 years, 68.9% were male, 16.2%
culturally and linguistically diverse (CALD) and 2.6% Aboriginal and Torres Strait
Islander peoples. At patient level, waiting time was median 15 (Interquartile range
[IQR] 9–25) days, 24.3% had an assessment before starting, 41.8% on completion, a
median 12 sessions (IQR 6–16) were delivered, which 59.1% completed and 75.4% were
linked to ongoing care.
At program level, using NACR criteria, 18.0% were classified as higher performing
and ≥87.1% met waiting time criteria, however, only 20.5% met duration criteria. Evidence
of inequitable access to higher performing programs was present with substantially
higher odds for participants living in major cities (OR 28.11 95%CI 18.41, 44.92)
and with every decade younger age (OR 1.89–2.94) and lower odds by 89.0% for principal
referral hospital-based services (OR 0.11 95%CI 0.08, 0.14) and 31.0% for people having
a CALD background (OR 0.69 95%CI 0.49, 0.97).
Conclusions
This study provides initial national CR performance benchmarks for quality improvement
in Australia. While wait times are minimised, few programs are higher performing or
met minimum duration standards. There is an urgent need to resource and support CR
quality and access outside of major cities, in principal referral hospitals and for
older and diverse patients.
Keywords
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Article info
Publication history
Published online: February 12, 2020
Accepted:
January 11,
2020
Received in revised form:
November 12,
2019
Received:
August 25,
2019
Identification
Copyright
© 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
